We present a patient who was managed surgically for cholecystogastric fistula. The patient was presented with nonspecific symptoms (upper abdominal pain, belching) and, after being investigated, was proceeded for laparoscopic cholecystectomy for gallbladder stones. Unexpectedly, intraoperative, she was found to have cholecystogastric fistula, which was operated with open single-stage approach. We highlight the incidence of these cases, the difficult preoperative clinical presentation and possible diagnostic imaging; explain further about the different surgical approaches to manage these cases and finally review the literature regarding the presentation and the management of bilioenteric fistulas.
IntroductionThe COVID-19 pandemic provoked a change to normal surgical practice in the United Kingdom and led to an increase in acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse the management of patients presenting with AA to our institution during the first wave of the pandemic, comparing surgically and conservatively managed patients. MethodAll patients presenting to our centre with AA between March and July 2020 were included. Six-month followup data were collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcomes were length of hospital stay and Alvarado score. ResultsFifty-seven patients (n=57) were admitted with AA, 45.6% (n=26) managed conservatively compared to 54.4% (n=31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not found to be statistically significant (16% vs 35%; p=0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p=0.012 and p=0.028, respectively). ConclusionsCOVID-19 has led to a significant cohort of conservatively managed AA patients in the United Kingdom. We propose a stratification pathway based on clinical severity, Alvarado score and imaging to facilitate safe selection for conservative management of AA, in order to reduce failure of treatment rates in this patient group. Further UK-based studies will add to the evidence-based surrounding safe management of AA with conservative treatment.
Introduction The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients. Method All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay. Results Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively). Conclusions Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.
Aims We report our experience with a cellular porcine dermal non-crosslinked biological mesh (EGIS®). We conducted a review of indications and outcomes of patients requiring the mesh for incisional hernia/complex abdominal wall reconstruction with component separation, parastomal hernia repairs and ELAPE. Patients were followed for a minimum of 6 and assessed for recurrence, seroma formation and chronic pain. Secondary outcome was the assessment of ease of use by the Surgeon – suturing and pliability. Method A retrospective case notes review of patients requiring biological mesh (EGIS®) from 2016 to present. A qualitative survey about ease of use of EGIS® for operations studied was sent to all Consultant Surgeons. Results EGIS® mesh was used in 38 patients: 23 Hernia repairs – 13 Incisional, 8 Parastomal, 2 Paraumbilical; 12 Pelvic floor repairs after ELAPE; and 3 abdominal wall reconstructions. Hernia recurrence occurred in 12 (32%), seroma 7 (18%) and chronic pain 7 (18%). The highest complications occurred in the incisional and parastomal hernia groups. Incisional hernia: recurrence in 5 (38%), seroma in 5 (38%) and chronic pain in 3 (23%). Parastomal hernia: recurrence in 3 (38%), chronic pain 2 (25%), seroma 1 (13%). Consultants scored the mesh 4.3 to 4.5 out of 10 for pliability, ease of use and suturing. Conclusion Biological mesh is used to reinforce hernia repairs in contaminated or potentially contaminated fields. Non-crosslinked meshes are preferred for their greater cellular infiltration from host tissue with improved integration. Our experience with this mesh shows a high complication rate and requires re-evaluation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.